Is Your Atopic Dermatitis Well-Controlled? 3 Red Flags You Should Watch For

For anyone living with moderate-to-severe atopic dermatitis, regular flare-ups and a high tolerance for discomfort are common. Most people develop this type of eczema before age 6, but not everyone develops the condition so young. “Uncontrolled eczema involves persistent itch, requiring steroids because of frequent flares and sleep disruption, as well as psychosocial factors,” says Trisha Khanna, MD , a board-certified dermatologist in Orlando, Florida. Over time, standard treatments such as emollients and topical steroids may not be enough, making it crucial to recognize the warning signs of poorly controlled eczema. If initial treatments aren’t effective, dermatologists may recommend additional options, including Janus kinase (JAK) inhibitors, biologics, or phototherapy. But it can be challenging to distinguish between eczema that’s simply persistent and eczema that requires a new approach. Here are three red flags that signal it may be time to talk to your dermatologist about different treatment options.
The Treatment Red Flag: Flares Become More Frequent and Intense The Treatment Red Flag If you feel like you’re constantly chasing down flares, rather than preventing them, it may be a sign you need a new way to manage the condition. But this will depend on which of the three stages of atopic dermatitis you’re in: Acute presents with skin that is red, itchy, and oozing. “This usually means it’s actively inflamed, with poor control,” says Dr. Khanna. Subacute has less weeping skin and some scaling. This stage typically means the flare is partially controlled and you’re on the road to recovery. Chronic means there is lichenification, which is characterized by thick, leathery, and sometimes discolored skin. “This can mean it’s long standing and undertreated,” says Khanna. Your dermatologist may prescribe new or different treatments based on the stage, as well as the SCORAD (Scoring Atopic Dermatitis) index, which can help further evaluate symptoms and how strongly they’re currently affecting you.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290448ee3d-8724-4072-83de-1a1452da4ed3
The Lifestyle Red Flag: Eczema Affects Sleep and Mental Health The Lifestyle Red Flag When eczema starts to affect how you go about your day, it might be time to check with your dermatologist about different treatment options. Poorly controlled atopic dermatitis can have a significant impact on quality of life, says Khanna. “You’re really itchy at night, so you get sleep deprivation. You have a hard time concentrating at school or work.” On top of that, there’s the stigma of eczema to consider. “There’s all sorts of psychosocial elements because you have eczema,” says Tanya Kormeili, MD , a board-certified dermatologist in Santa Monica, California. “Your skin may feel rough and scaly when you want it to feel smooth. And if you’re shedding a lot, you might leave flakes behind on furniture, which could be embarrassing.” Adults with atopic dermatitis are at greater risk of anxiety and depression than those without atopic dermatitis, so it’s important to be aware of how much flares are affecting your mental health and day-to-day life.e60dc2a1-f33c-4a05-9b50-8e3e8e59762921f09bc2-7440-43b6-8e05-cdba4729dd4f Talk to your dermatologist about supplemental treatments to try, as well as therapy or counseling.
The Functional Red Flag: Treatment Stops Working The Functional Red Flag Finally, if you’re spending lots of time using topical treatments and barely getting any relief, it may be time to revisit your care plan. You may require more systemic (body-wide) solutions to help alleviate symptoms from the inside out. For example, Dr. Kormeili says, you may be prescribed a short-term medication, such as a fast-acting corticosteroid like prednisone, initially. “We usually use that as a starting point to blast some relief for the patient, and then we think of plan B,” she says, noting that prednisone can affect your organs, causing brittle bones, diabetes, glaucoma, or hypertension. From there, Kormeili says your doctor might prescribe less-traditional treatments, including immunosuppressants, sometimes on a rotating basis to reduce negative side effects. Or they may suggest a JAK inhibitor or biologic, which she says has become more popular in recent years, due to being a relatively safe medication.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bfbe944b-b341-47c2-b4ea-02527763fd0f But even these treatments can stop working or become less effective, so it’s important to track flares and communicate their frequency and intensity with your doctor. Ultraviolet light therapy is another option. “Sometimes people benefit from being in a light box, because it can lower the inflammation in the skin,” says Kormeili. Talk this option through with your dermatologist, though, as it does carry a risk of skin cancer for people with lighter skin. Ultimately, Kormeili says, these are tough clinical decisions that need to be made with your dermatologist. Together, you can work to find a new treatment plan that meets your specific needs and goals.
The Takeaway People with moderate-to-severe atopic dermatitis require careful monitoring and need to be aware of signs that the current treatment plan is not working effectively. If the frequency or severity of eczema flare-ups appears to be increasing, it may be time to visit your dermatologist. When eczema symptoms are heavily affecting your ability to sleep or overall mental health, consider revising the treatment plan or discussing supplemental therapies with your doctor. Topical treatments can sometimes only do so much. If they feel less effective, your doctor may prescribe a wide range of systemic treatments, including JAK inhibitors, biologics, or immunosuppressants.